Lead exposure later in life has been associated with chronic disease and adverse overall health outcomes. Occupational hazards are the predominant cause of increased lead levels in adults. In this study, we assessed whether increased blood lead levels are associated with cardiovascular disease (CVD) among people with diabetes. The study was conducted on adults aged 55 years or older living in the United States from the National Health and Nutrition Examination Survey (NHANES) survey for the years 1999 to 2018. Diabetes and CVD were ascertained through self-reported data. Blood lead levels (BLL’s) were considered to be elevated at ≥ 1.30 μg/dL. Cross-sectional analysis was performed using complex samples logistic regression with adjustment for known confounders to determine the relationship of elevated lead levels and CVD, as experienced by patients who have diabetes. For CVD, the overall unadjusted odds ratio (OR) of elevated BLL to normal BLL was 1.46 (95% confidence interval [CI], 1.23-1.73, p < 0.01). Adjusted OR was elevated, 1.32 (CI 1.07-3.30, p < 0.01), among patients with diabetes and elevated BLLs but closer to 1.0 (1.01 CI 0.88-1.15, p = 0.92) among patients without diabetes and normal BLLs, after controlling for medical (hypertension and obesity) and demographic risk factors (age, ethnicity, smoking status, education, marital status, and poverty-income-ratio). There was a complex interplay between elevated BLLs, diabetes, and CVD with a direct linkage between elevated BLLs and CVD. For people with diabetes, elevated BLLs may lead to more severe outcomes. Assessment for CVD should include biomonitoring of environmental health factors to identify and prevent poor potential outcomes.